Quinoline drugs (delagil, plavinil). Among the most studied mechanisms of action, stabilization of lysosomal membranes, inhibition of leukocyte chemotaxis can be noted. Due to active binding with nucleic acids, they have a mild cytostatic effect, which is probably the main component of their therapeutic action.
The main indicator for the use of quinoline preparations is considered to be a chronic immuno-inflammatory process with a slight activity. When prescribing these drugs, it is necessary to take into account that the effect develops slowly and it is possible to judge it with certainty not earlier than 6-9 months from the start of therapy.
D-penicillamine (cuprenyl, metalcaptase). From the biological properties of the drug, the following are known: inhibition of collagen synthesis, dissociation of macromolecular protein complexes, binding of ions of metals such as mercury, lead, nickel, and copper. However, to date it is not clear how these properties are associated with the therapeutic effect of D-penicillamine in YUHA and RA.
In RA, D-penicillamine has proven itself in active forms that are not amenable to therapy only with NSAIDs. Additional indications for the use of these drugs may be the presence of high titers of rheumatoid factor, rheumatoid nodules, vasculitis, Felty syndrome. The experience of using this drug in children is still small, however, according to our observations, it turned out to be the most effective in sub-current forms of chronic arthritis.
The drug belongs to the slowly acting and therapeutic effect is observed after 6-9 months of continuous treatment.
Preparations of gold. According to modern concepts, gold preparations are considered the best of the long-acting in RA. To date, the mechanism of action of drugs of gold has not been elucidated. Their inhibitory effect on prostaglandin synthesis, complement activity, phagocytic activity of neutrophils and macrophages is proven. There is evidence of changes in the structure of IgG in such a way that it ceases to induce the production of autoantibodies (rheumatoid factors).
Of the drugs of this group in the Soviet Union, krizanol (calcium-aurotype-propanol-sulphate oil suspension) is used, myocryzine (aurothiuabloic acid sodium salt) is used abroad; recently, the drug for oral administration is auranofine.
It is believed that gold therapy is indicated for any form of RA in the absence of the effect of the previous treatment of NSAIDs. The drugs act for a long time and the first effects appear in 2-4 months from the start of therapy and only with the continuous use of drugs. The use of gold preparations in children is limited due to the poor tolerability of injecting, especially criszanol.
Table 15 shows the daily doses, the timing of the onset of the effect and the typical side effects of the drugs most commonly used in the treatment of UHA and RA.
In conclusion of the section on drug treatment, we present the treatment plan for YUHA, developed at the Department of Propedeutics of Children’s Diseases and recommended for use by the Scientific and Medical Council for Cardiorheumatology under the General Directorate of Health Care in Leningrad.